Leveraging A Low-Intensity Behavioral Intervention for HIV Care to Target Depressive Symptoms in People Living with HIV

利用低强度行为干预进行艾滋病毒护理，以针对艾滋病毒感染者的抑郁症状

• 批准号: 10764605
• 负责人: Simone Schriger
• 金额: $ 1.8万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2023-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10764605
• 关键词: Acquired Immunodeficiency Syndrome; Address; Affect; African; Behavior Therapy; Benchmarking; Black race; Canada; Caribbean region; Caring; Clinic; Clinical; Community Health Aides; County; Data; Depressed mood; Discrimination; Disease Progression; Disease remission; Effectiveness; Evidence based practice; Feeling suicidal; Fellowship; Funding; General Population; Goals; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; HIV/AIDS; Health; Health Benefit; Health Services Accessibility; Improve Access; Individual; Inequity; Internships; Intervention; Interview; Investments; Latinx; Lesbian Gay Bisexual Transgender Queer; Literature; Mediating; Mediation; Mediator; Medical; Mental Depression; Mental Health; Mental Health Services; Mentorship; Modeling; National Institute of Mental Health; Newly Diagnosed; Ontario; Patient Care; Patients; Perception; Persons; Philadelphia; Population; Poverty; Problem Solving; Provider; Psyche structure; Psychiatry; Psychological Factors; Public Health; Qualitative Methods; Quality of life; Quasi-experiment; Randomized, Controlled Trials; Reduce health disparities; Research; Research Personnel; Research Project Grants; Resource-limited setting; Resources; Role; Self Efficacy; Sex Discrimination; Statistical Methods; Stress; Structure; Target Populations; Testing; Therapy trial; Training; Trauma; United States; Viral; Work; antiretroviral therapy; base; behavioral health; black women; burnout; career; chronic pain; clinical practice; cohort; comorbid depression; comparison group; comparison intervention; contextual factors; depressive symptoms; design; disability; disparity reduction; evidence base; experience; follow-up; food insecurity; future implementation; health equity; health inequalities; health related quality of life; high risk; housing instability; implementation determinants; implementation efforts; implementation intervention; implementation questions; implementation science; improved; insight; interest; intervention effect; marginalization; medication compliance; mortality; population health; problem solving therapy; prospective test; racial discrimination; randomized trial; scale up; skills; social stigma; stakeholder perspectives; structural determinants; suicidal; suicidal risk; symptom management; syndemic; therapy adherence; time use; treatment as usual

PROJECT SUMMARY People living with HIV (PLWH) experience depression at nearly two times the rate of the general population, leading to decreased quality of life,1 more rapid HIV disease progression,2 increased suicide risk,3 and increased mortality.4 In the United States, PLWH are disproportionately Black or Latinx, LGBTQ+, and living in poverty. Access to mental health services among this population is limited by myriad contextual barriers related to individual and structural factors (e.g., stigma,5 discrimination,6 poverty,7 food insecurity,8) and implementation factors (e.g., provider burnout, insufficient public funding). These challenges in accessing mental health treatment exacerbate existing inequities within this population. There is an urgent need for effective, feasible, and scalable treatment for depression in PLWH that overcomes existing access barriers. Managed Problem Solving Therapy (MAPS), a low-intensity behavioral intervention to increase medication adherence in PLWH, is an evidence-based practice endorsed by the CDC. Although MAPS was designed to specifically target medication adherence, when tested in a randomized-controlled trial, depressed PLWH receiving this treatment were twice as likely to experience depression remission compared to those receiving usual care.9,10 MAPS+, an adapted version of MAPS that focuses on medication adherence and care retention, will be delivered by community health workers (CHWs) in Philadelphia HIV clinics in an R01-funded trial (NR 019753; Momplaisir, Beidas, Gross). My proposed project builds upon the R01 project, adding a behavioral health component by 1) prospectively testing the effect of MAPS+ on depressive symptoms; 2) examining the mechanism by which MAPS+ affects depressive symptoms; 3) addressing crucial implementation questions related to mental health and health equity that are relevant to scaling up this intervention. Quantitative data will be collected from ~100 PLWH across 4 clinics over one year and will be compared to a cohort of similar patients from the same clinics from an earlier time using propensity score matching. The hypothesized mechanism of action, that MAPS+ decreases depressive symptoms by increasing self-efficacy, will be tested using mediation modeling. The proposed project also includes a qualitative aim involving multi-level stakeholders. Thirty qualitative interviews with patients, CHWs, and clinic leaders will capture perspectives on contextual barriers and facilitators to MAPS+ implementation to inform future implementation efforts in Philadelphia and beyond and to advance health equity goals. This fellowship opportunity will provide the applicant with advanced training in implementation science and statistical methods through didactics and formal mentorship. Further, carrying out the proposed research project will provide the applicant with an opportunity to develop independent research skills that will prepare her to carry out her long-term career goal of improving access to mental health care in resource-limited settings by leveraging low-intensity interventions. 1. Sherbourne CD, Hays RD, Fleishman JA, et al. Impact of psychiatric conditions on health-related quality of life in persons with HIV infection. Am J Psychiatry. 2000;157(2):248-254. doi:10.1176/appi.ajp.157.2.248 2. Leserman J. Role of depression, stress, and trauma in HIV disease progression. Psychosom Med. 2008;70(5):539-545. doi:10.1097/PSY.0b013e3181777a5f 3. Carrico AW, Johnson MO, Morin SF, et al. Correlates of suicidal ideation among HIV-positive persons. AIDS. 2007;21(9):1199-1203. doi:10.1097/QAD.0b013e3281532c96 4. Villes V, Spire B, Lewden C, et al. The effect of depressive symptoms at ART initiation on HIV clinical progression and mortality: Implications in clinical practice. Antivir Ther. 2007;12(7):1067-1074. 5. Goodin BR, Owens MA, White DM, et al. Intersectional health-related stigma in persons living with HIV and chronic pain: implications for depressive symptoms. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2018;30(sup2):66- 73. doi:10.1080/09540121.2018.1468012 6. Logie C, James L, Tharao W, Loutfy M. Associations between HIV-Related stigma, racial discrimination, gender discrimination, and depression among hiv-positive african, caribbean, and black women in Ontario, Canada. AIDS Patient Care STDS. 2013;27(2):114-122. doi:10.1089/apc.2012.0296 7. Oldenburg CE, Perez-Brumer AG, Reisner SL. Poverty matters: Contextualizing the syndemic condition of psychological factors and newly diagnosed HIV infection in the United States. AIDS. 2014;28(18):2763-2769. 8. Turan JM, Elafros MA, Logie CH, et al. Challenges and opportunities in examining and addressing intersectional stigma and health. BMC Med. 2019;17(1):1-15. doi:10.1186/s12916-018-1246-9 9. Gross R, Bellamy SL, Chapman J, et al. The effects of a problem solving-based intervention on depressive symptoms and HIV medication adherence are independent. PLoS One. 2014;9(1):84952. 10. Gross R, Bellamy SL, Chapman J, et al. Managed problem solving for antiretroviral therapy adherence: A randomized trial. JAMA Intern Med. 2013;173(4):300-306. doi:10.1001/jamainternmed.2013.2152

项目概要 艾滋病毒感染者（PLWH）患抑郁症的比率几乎是普通人群的两倍， 导致生活质量下降，1 HIV 疾病进展更快，2 自杀风险增加，3 并增加 4 在美国，感染者中黑人或拉丁裔、LGBTQ+ 人群比例过高，且生活贫困。 该人群获得心理健康服务的机会受到与以下方面相关的无数背景障碍的限制： 个人和结构因素（例如耻辱、5 歧视、6 贫困、7 粮食不安全、8）和实施情况 因素（例如，提供者倦怠、公共资金不足）。获得心理健康方面的这些挑战 治疗加剧了这一人群中现有的不平等。迫切需要有效、可行、 以及针对艾滋病患者抑郁症的可扩展治疗，克服现有的准入障碍。管理问题 解决疗法 (MAPS) 是一种低强度行为干预，旨在提高 PLWH 的药物依从性 CDC 认可的循证实践。尽管 MAPS 的设计目的是专门针对 在随机对照试验中测试药物依从性时，接受这种治疗的 PLWH 抑郁 与接受常规护理的人相比，抑郁症得到缓解的可能性是接受常规护理的人的两倍。9,10 MAPS+，一种 MAPS 的改编版本侧重于药物依从性和护理保留，将由 费城艾滋病毒诊所的社区卫生工作者 (CHW) 参与 R01 资助的试验（NR 019753；Momplaisir， 贝达斯，格罗斯）。我提议的项目建立在 R01 项目的基础上，添加了行为健康组件 1) 前瞻性测试 MAPS+ 对抑郁症状的影响； 2）检查其机制 MAPS+ 影响抑郁症状； 3）解决与心理健康相关的关键实施问题 和与扩大这种干预措施相关的健康公平。定量数据将从〜100个中收集 一年内 4 个诊所的 PLWH 数据将与来自同一诊所的一组类似患者进行比较 从较早的时间开始使用倾向得分匹配。假设的作用机制，MAPS+ 通过提高自我效能来减少抑郁症状，将使用中介模型进行测试。这 拟议项目还包括涉及多层次利益相关者的定性目标。三十次定性访谈 与患者、社区卫生工作者和诊所领导者将了解有关 MAPS+ 的背景障碍和促进因素的观点 为费城及其他地区未来的实施工作提供信息，并促进健康公平 目标。该奖学金机会将为申请人提供实施科学方面的高级培训 以及通过教学和正式指导的统计方法。此外，开展拟议的研究 项目将为申请人提供发展独立研究技能的机会，为她做好准备 实现她的长期职业目标，即在资源有限的环境中改善获得精神卫生保健的机会 利用低强度干预措施。 1. Sherbourne CD、Hays RD、Fleishman JA 等。精神疾病对健康相关生活质量的影响 艾滋病毒感染者。 《J 精神病学》。 2000；157(2)：248-254。 doi:10.1176/appi.ajp.157.2.248 2. Leserman J. 抑郁、压力和创伤在 HIV 疾病进展中的作用。心理医学。 2008；70(5)：539-545。 doi:10.1097/PSY.0b013e3181777a5f 3. Carrico AW、Johnson MO、Morin SF 等人。 HIV 阳性者自杀意念的相关性。艾滋病。 2007；21(9)：1199-1203。 doi:10.1097/QAD.0b013e3281532c96 4.Villes V、Spire B、Lewden C 等人。 ART 开始时抑郁症状对 HIV 临床进展的影响 和死亡率：临床实践的影响。安替维尔疗法。 2007；12(7)：1067-1074。 5. Goodin BR、Owens MA、White DM 等人。艾滋病毒感染者和慢性病感染者与健康相关的交叉耻辱 疼痛：对抑郁症状的影响。艾滋病护理 - 心理社会医学 Asp 艾滋病/艾滋病毒。 2018；30（补充2）：66- 73.doi：10.1080/09540121.2018.1468012 6. Logie C、James L、Tharao W、Loutfy M。艾滋病毒相关耻辱、种族歧视、性别之间的关联 加拿大安大略省艾滋病毒呈阳性的非洲、加勒比和黑人妇女受到歧视和抑郁。艾滋病 病人护理 STDS。 2013；27(2)：114-122。 doi:10.1089/apc.2012.0296 7. 奥尔登堡 CE、佩雷斯-布鲁默 AG、赖斯纳 SL。贫困很重要：结合流行病的情况 心理因素和美国新诊断的艾滋病毒感染。艾滋病。 2014；28(18):2763-2769。 8. Turan JM、Elafros MA、Logie CH 等人。检查和解决交叉问题的挑战和机遇 耻辱和健康。 BMC 医学。 2019；17(1):1-15。号码：10.1186/s12916-018-1246-9 9. Gross R、Bellamy SL、Chapman J 等人。基于问题解决的干预对抑郁症的影响 症状和 HIV 药物依从性是独立的。公共科学图书馆一号。 2014；9(1):84952。 10. Gross R、Bellamy SL、Chapman J 等人。抗逆转录病毒治疗依从性的管理问题解决：A 随机试验。 JAMA 实习医生。 2013；173(4)：300-306。 doi:10.1001/jamainternmed.2013.2152